Migraine comorbidity in epilepsy subtypes: Association with focal versus generalized epilepsy and seizure control-A systematic review and meta-analysis.

Migraine and epilepsy are paroxysmal neurological disorders that frequently co-occur and share common pathophysiological mechanisms. Whether comorbid migraine is associated with epilepsy subtypes (focal vs. generalized) and with seizure control remains poorly understood. This systematic review and meta-analysis aimed to evaluate these associations. This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed and Web of Science databases were searched from inception to April 1, 2026. Studies ascertaining migraine using the formal diagnostic criteria defined by the International Headache Society or a predefined migraine ascertainment method, including validated screening instruments or questionnaires, were included. Methodological quality was assessed using the Newcastle-Ottawa Scale, and studies scoring seven or higher were included in a random-effects meta-analysis. A total of 8250 records were identified; 15 studies were included in the qualitative synthesis and six in the quantitative synthesis. Migraine comorbidity was not significantly associated with epilepsy subtypes (odds ratio [OR] = 1.10, 95% confidence interval [CI] = .84-1.43; I2 = 32.1%). The primary analysis showed no significant association between comorbid migraine and favorable seizure control status (OR = .70, 95% CI = .45-1.11; I2 = 63.2%). However, a separate exploratory, hypothesis-generating sensitivity analysis yielded an exploratory association between comorbid migraine and less favorable seizure control outcomes (OR = .61, 95% CI = .41-.91; I2 = 47.6%); all pooled estimates were based on unadjusted data. Current data did not show a significant difference in migraine comorbidity between focal and generalized epilepsy. Although the overall analysis found no significant link between comorbid migraine and favorable seizure outcomes, an exploratory, hypothesis-generating sensitivity analysis suggested a possible association with less favorable seizure control, warranting confirmation through prospective, syndrome-specific studies with standardized outcome measures.